Biliary Sepsis as a Cause of Appearance of Endoluminal Tc-99m HMPAO-Labeled Leukocytes: A Case Report

A case is presented that shows the abnormal early appearance of Tc-99m HMPAO-labeled leukocytes within the small bowel lumen as a result of septic cholangitis. It is essential to perform early images with Tc-99m HMPAO-labeled leukocytes to differentiate between the appearance of abnormal uptake in the bowel and normal physiologic excretion, which occurs later in the renal and biliary tracts. Endoluminal radiolabeled leukocytes have been described in several clinical settings unrelated to bowel disease, such as swallowed activity from sinus or pulmonary infection, and it is important to differentiate this from primary gastrointestinal disease. To our knowledge, acute pyogenic cholangitis has not been shown previously as a cause of these appearances and should be included in the differential diagnosis for the early appearance of mobile radiolabeled leukocytes in the lumen of the gastrointestinal tract. {aff}From the Department of Nuclear Medicine, Division of Imaging Services, Royal Perth Hospital, Perth, Australia